ISSUE 1 | 2015 PENNOTORHINOLARYNGOLOGY HEAD AND NECK SURGERY

EMERGING MULTI-KINASE INHIBITORS IN ADVANCED THYROID CARCINOMA

2 Letter from the Chair 3 Emerging Multi-kinase Inhibitors in Advanced Thyroid Carcinoma 7 Obstructive Sleep Apnea INSIDE Treatment Expansion 8 HPV+ Oropharyngeal Cancer Treatment Deintensification 10 New Penn Faculty 11 New Penn Facilities LETTER FROM THE CHAIR

Dear Colleagues, It is my honor to present the 2015 Penn Otorhinolaryngology–Head and Neck Surgery Newsletter. This issue features groundbreaking advances in treatment, a retrospective review of the department’s focused efforts to deintensify head and neck cancer treatment for HPV positive patients, an expanded FDA approval for TransOral Robotic Surgery (TORS), and other department developments over the past year.

The pioneering work of world-renowned researcher Marcia Brose, MD, PhD has dramatically altered the outlook for thyroid cancer patients. An Associate Professor at Penn Medicine, Dr. Brose was instrumental in the development and 2013 FDA approval of the multi-kinase inhibitor for the treatment of metastatic and Bert W. O’Malley, Jr., MD advanced RAI-refractory differentiated thyroid carcinoma. That story, Gabriel Tucker Professor and Chair Department of Otorhinolaryngology - Head and Neck Surgery and Dr. Brose’s recent research on expanded multi-kinase inhibitor Associate Vice President, University of Pennsylvania Health System treatment are reported in this issue.

TORS — a surgical approach developed at Penn Medicine — has been used in the context of diagnosed oropharyngeal squamous cell cancers (OPSCC), with a focus on HPV positive patients. In research #3 in the Nation performed at Penn, TORS has been found to be highly effective in Penn Otorhinolaryngology – Head and Neck Surgery at the management of OPSCC independent of HPV status. Generally these HPV positive patients are younger, much less likely to have the hospitals of the University of Pennsylvania – the traditional risk factors associated with OPSCC and much more Penn Presbyterian is ranked #3 among the top likely to respond to treatment. Clinical trials are underway at Penn to investigate deintensified treatments including TORS in patients with Ear, Nose, and Throat departments in the nation by OPSCC caused by p16+ human papilloma virus infection. U.S. News & World Report for 2014. You will also find updates about recent and newsworthy events in this issue: developments in TORS for obstructive sleep apnea, recent expansions for our department at Penn Medicine Washington Square, the Perelman Center for Advanced Medicine and Penn Medicine University City, and new faculty profiles.

For more news about our research, objectives and future, please visit us at PennMedicine.org/ent.

Best Regards,

EXCELLENCE IN PATIENT CARE, EDUCATION Bert W. O’Malley, Jr., MD Gabriel Tucker Professor and Chair, Department of Otorhinolaryngology - Head and Neck Surgery AND RESEARCH SINCE 1870 Associate Vice President, University of Pennsylvania Health System

2 PENN OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY

Thyroid Cancer Treatment Success Continues EMERGING at Penn Medicine Marcia Brose, MD, PhD, a medical oncologist for Penn MULTI-KINASE Otorhinolaryngology - Head and Neck Surgery, was among the first investigators in the world to recognize the potential of the multi-kinase inhibitor (MKI) sorafenib for the treatment of thyroid cancer. Following INHIBITORS a series of clinical trials for which Dr. Brose was the primary investigator, IN ADVANCED sorafenib was FDA approved for the treatment of metastatic and advanced radioactive iodine (RAI)-refractory differentiated thyroid carcinoma THYROID CARCINOMA (DTC) in 2013, becoming the first approved treatment for the disease since 1974. At Penn Medicine, the sorafenib trials marked the initiation of a progressive and continuing series of investigations into MKIs for the treatment of thyroid cancer.

Targeting Cell Signaling in Thyroid Cancer

Tumor Cell Endothelial Cell RET/PTC RET/PTCEGFR EGFR VEGFR-2 VEGFR-2

Motesanib Motesanib Vandetanib Axitinib Sorafenib Sorafenib Motesanib Motesanib Sunitinib Sorafenib Sorafenib Vandetanib Vandetanib Sunitinib Sunitinib Cabozantinib Vandetanib Vandetanib RasLenvatinib Ras Ras LenvatinibRas Lenvatinib P13K P13K Cabozantinib Cabozantinib Sorafenib Sorafenib Sorafenib Raf P13K Raf P13K Sorafenib B-Raf B-Raf AKT AKT MEK AKT MEK AKT MEK MEK mTOR mTOR Everolimus Everolimus ERK mTOR ERK mTOR ERK SirolimusERK Sirolimus Everolimus Everolimus SGK SGK Sirolimus Sirolimus SGK SGK

• GROWTH • HIF1A • GROWTH • HIF1A • SURVIVAL• • INHIBITION• SURVIVAL OF APOPTOSIS• • INHIBITION OF APOPTOSIS • GROWTH • MIGRATION• GROWTH • MIGRATION • PROLIFERATION • MIGRATION• PROLIFERATION • MIGRATION • SURVIVAL • ANGIOGENESIS• SURVIVAL • ANGIOGENESIS • PROLIFERATION • PROLIFERATION

EGFR, epidermal receptor; VEGFR, vascular endothelial growth facoor receptor. Graphic adapted from Keefe SM, et al. Clin Cancer Res. 2010;16:778-783. (Continued on page 4) 3 Thyroid Cancer: Clinical Pathways

Papillary (87%) Papillary (87%) Differentiated Follicular (6%) Follicular Cells Differentiated Follicular (6%) Follicular Cells Hürthle Cell (3%) Hürthle Cell (3%) Anaplastic (1%) Anaplastic (1%) Medullary (2%) Parafollicular Cells Medullary (2%) Parafollicular Cells

MORE ON RADIOACTIVE (Continued from page 3)

IODINE (RAI)-REFRACTORY Radioactive iodine (RAI) is used to kill thyroid cancer cells that are DIFFERENTIATED THYROID not cured by surgery alone. RAI can be curative in the majority of patients with the disease. Of patients with residual disease, however, CANCER (DTC) up to 50% will become refractory to RAI. This occurs either because their cells can no longer absorb RAI or are no longer inhibited by ffIt was estimated that in the USA in 2014 there RAI. Patients with RAI-refractory differentiated thyroid carcinoma would be: (DTC) were essentially beyond the scope of standard treatment, and • 62,000+ new cases of thyroid cancer had an average lifespan of 2.5 to 3.5 years. Their disease was defined by continuous progression, resulting in pulmonary, bone and brain • ~1,890 deaths due to thyroid cancer complications, among other concerns. ffTreatment of Differentiated Thyroid Cancer includes: • Surgery Treatment of RAI-Refractory Differentiated • Thyroidectomy Thyroid Cancer • Radioactive iodine The search for new options for the treatment of RAI-refractory • Thyroid stimulating hormone (TSH) suppression DTC was initiated by need and a greater understanding of thyroid • Recurrent progressive RAI refractory disease carcinogenesis and the role of targeted therapies. For the latter treated with sorafenib part of the twentieth century, the only drug approved to treat the condition was doxirubicin, a toxic, ineffective and thus little-used ffIn approximately 5–15% of patients with thyroid chemotherapeutic. The development of targeted cancer therapies cancer, the disease becomes refractory to RAI at the turn of the 21st century, however, allowed for a far more efficacious therapy to be found for RAI-refractory DTC. ffMedian survival for patients with RAI-refractory DTC and distant metastases is estimated to be 2.5–3.5 years Sorafenib was an early and likely prospect for this role. Developed in 1999 as a multi-kinase inhibitor (MKI), sorafenib inhibits a number ffPatients often suffer multiple complications of somatic mutations, including the angiogenic kinases VEGFR2, associated with disease progression VEGFR3 and mVEGFR2 as well as B-RAF, mutant B-RAF

4 PENN OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY

Decreased metabolic activity in two metastatic thyroid lesions in a patient before and after sorafenib treatment

Before After

At this time, Penn Medicine is a global leader in the development of novel therapies for patients with thyroid cancer.

V600E, and platelet-derived (PDGFR). least 30%. The average time to progression was ~18 months. That the VEGF gene is over-expressed in renal cell carcinoma On the basis of clear evidence of efficacy, the Phase II study was (RCC) has been known since 1992; a decade later, the B-RAF published early and Dr. Brose was invited to become the principal mutation was identified in melanoma. By 2003, sorafenib was in investigator for the DECISION trial. This was a Phase III, double- clinical trials for both diseases. blind, randomized study of sorafenib versus placebo in locally advanced or metastatic patients with RAI-refractory DTC. The At about this time, Marcia Brose, MD, PhD was investigating the DECISION trial demonstrated significantly extended progression- B-RAF pathway in melanoma and lung cancer at Penn Medicine. free survival (PFS) for patients taking sorafenib compared to Familiar with sorafenib, Dr. Brose suspected that the drug would placebo. The median PFS was 10.8 months among patients treated be effective against RAI-refractory DTC. In recent studies, the with sorafenib, compared to 5.8 months among patients receiving B-RAF V600E somatic mutation had been identified as the most placebo (HR=0.587 [95% CI, 0.454-0.758]; p<0.0001). common genetic change in papillary thyroid cancers; an association between thyroid cancer and the VEGF pathway had long been In 2013, sorafenib was approved by the FDA for the first-line known. Yet for patients with RAI-refractory DTC, sorafenib was treatment of metastatic and RAI-refractory differentiated thyroid available only through clinical trials for other indications. cancer.

Unexpectedly, researchers in the existing RCC trial expanded the Dr. Brose continues to investigate sorafenib and other new MKIs study to examine hypertension in patients taking sorafenib, whether for patients with all types and stages of thyroid cancer. Her work or not they had renal cell carcinoma. Given this opportunity, has contributed to the FDA approval of the multi-kinase inhibitor Dr. Brose and her colleagues at Penn treated a patient with cabozantinib (an inhibitor of MET, VEGFR2 and RET) for the RAI-refractory DTC with sorafenib. The patient’s response was treatment of advanced medullary thyroid cancer, and the completion remarkable, and based on this result, Dr. Brose initiated a Phase II of SELECT, a Phase 3 study of lenvatinib (another highly effective trial at Penn. kinase inhibitor) for RAI-refractory DTC.

This open-label study involved up to 60 patients with metastatic At this time, Penn Medicine is a global leader in the development RAI-refractory DTC, and resulted in clinical benefit for 82% of of novel therapies for patients with thyroid cancer. patients. About a third of patients saw regression in tumor size of at (Continued on page 6)

5 ONGOING KINASE INHIBITOR STUDIES INCLUDE THE FOLLOWING:

(Continued from page 5) A Phase II Trial of Cabozantinib for the Treatment Study Comparing Complete Remission After of Radioactive Iodine (RAI)-Refractory Differentiated Treatment with /Placebo in Patients Thyroid Carcinoma (DTC) in the First-line Setting with Differentiated Thyroid Cancer (ASTRA) This is a phase II, non-randomized, open-label study to This randomized, double-blind study is designed to evaluate the determine the efficacy of cabozantinib as a firstline treatment clinical efficacy, safety and tolerability of selumetinib (an orally for patients with RAI-refractory differentiated thyroid cancer. active, small molecule ATP-independent inhibitor of mitogen- Subjects will receive the drug at a starting dose of 60mg orally, activated protein kinase (MEK or MAPK/ERK kinase) 1 and 2) daily. Subjects can receive the drug as long as they continue to over a five week period prior to radioactive iodine (RAI). Patients derive clinical benefit or until they experience unacceptable will be randomized to receive one of the following: drug-related toxicity. As a first-line treatment for RAI-refractory ff1) Selumetinib plus radioactive iodine (RAI) therapy with thyrogen DTC, cabozantinib might offer a treatment option for patients (recombinant human TSH) to stimulate iodine uptake in addition to sorafenib. ff2) Placebo plus RAI

A Phase II Study of Everolimus and Sorafenib in The dose of selumetinib is three 25 mg capsules orally twice daily. Patients with Metastatic Differentiated Thyroid The primary objective of the trial is to compare the complete Cancer (DTC) Who Progressed on Sorafenib Alone remission rate in the overall study population. The primary objective of this study is to determine the effect of combining the mTOR (mammalian target of rapamycin) Evaluation of Efficacy, Safety of Vandetanib in inhibitor everolimus and sorafenib in patients with metastatic Patients with Differentiated Thyroid Cancer (VERIFY) DTC who have progressed on sorafenib alone. mTOR is a kinase that regulates many cellular processes in cancer, including This randomized, double-blind, placebo-controlled, multi-center metabolism, proliferation and angiogenesis. Phase III study will assess the efficacy, safety and tolerability of the VEGFR inhibitor vandetanib, 300 mg daily, versus placebo Secondary outcome measures include the performance of in patients with locally advanced or metastatic differentiated correlative scientific studies to determine the relationship between thyroid cancer who are refractory or unsuitable for radioactive clinical response to everolimus and sorafenib and multiple iodine therapy. The primary outcome is to determine the efficacy parameters including: (as assessed by progression-free survival) of vandetanib when compared to placebo in the patient population. ffThe mutational status of BRAF, N-RAS and other relevant cancer genes in the tumor ffTime to disease progression in patients receiving everolimus and sorafenib Patients and investigators wishing to contact ffAn evaluation of the activity of additional signaling Dr. Brose or the thyroid cancer clinical pathways in surrogate tissue and tumor samples and their research team at Penn Medicine may call relevance to outcome measures 215-615-5858, or make an appointment at [email protected].

6 PENN OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY

TRANSORAL ROBOTIC SURGERY FOR TONGUE BASE OBSTRUCTION IN OBSTRUCTIVE SLEEP APNEA

provide an alternative to open surgery in head and neck procedures. Recently, Dr. O’Malley, Dr. Weinstein, and a colleague at Penn Medicine, otorhinolaryngologist Erica Thaler, MD, conducted a clinical trial to evaluate standard UPPP coupled with TORS tongue base resection in patients with obstructive sleep apnea complicated by tongue base obstruction. Preliminary findings of this trial were published in the Annals of Otology, Rhinology and Laryngology in 2012.

At this time, 65% of patients had responded to surgery. A significant decline in apnea-hypopnea index occurred (56.7%; p < 0.001) and there were significant improvements in mean preoperative to postoperative minimum arterial oxygen saturation values (75.8% to 81.7%; p = 0.013). In addition, a significant improvement in the Epworth Sleepiness Scale score occurred, In September 2014, The Food and Drug Administration expanded its from 13.4 to 5.9 (p = 0.003). indication for the use the of transoral robotic surgery (TORS) for benign base of tongue resection procedures. The clinical trials for this indication originated at Penn Medicine under the direction of Erica Thaler, MD The division is also exploring other methods and approaches in which benign tongue base resection was used for the treatment of to the treatment of OSA and will be reporting on these obstructive sleep apnea. developments in the near future. The treatment of obstructive sleep apnea (OSA) often combines two procedures, uvulopalatopharyngoplasty (UPPP) and lingual tonsillectomy, that address the separate contributory factors of the condition. UPPP is used to remove all or part of the soft tissues at the rear of the mouth, including the uvula, soft palate and tonsils, while lingual tonsillectomy trims lymphatic tissue from the surface of the tongue. While neither procedure is particularly effective as treatment alone, in combination the surgeries have been shown to ameliorate OSA in a majority of patients.

Tongue base surgery generally presents a variety of challenges, however, including the difficulty of manipulating surgical instruments in a limited operative field, visualization with endoscopic instruments and the occasional need for concomitant tracheotomy and/or other external incisions during surgery. Transoral robotic surgery (TORS) was developed at Penn Medicine by Bert O’Malley Jr., MD and Gregory Weinstein, MD, FACS to Erica Thaler, MD

7 TRANSORAL ROBOTIC SURGERY IN PATIENTS WITH HPV+ OROPHARYNGEAL CANCER

In the developed world, more than half of newly diagnosed oropharyngeal At present, treatment regimens for patients with OPSCC do squamous cell cancers (OPSCC) will test positive for p16, a marker for not distinguish between patients with, and those without, HPV. the human papilloma virus (HPV). This means, at many centers, patients with a demonstrably milder course of disease commonly receive the same regimen—high The recent history of oropharyngeal cancers has been defined by dose chemotherapy and radiation—administered to patients with an etiologic paradox: a decrease in the incidence of oral cancers severe and aggressive OPSCC, but must live much longer with the coincident with an increased incidence of oropharyngeal cancers functional and psychological magnitude of treatment. (more than 90% of which are squamous cell malignancies). The drop in oral cancers has been attributed to a 50-year long decline in Clinical trials at Penn Medicine and elsewhere are thus investigating tobacco use, which paired with alcohol abuse, had once comprised the potential for deintensification of therapy in patients with the traditional pathology of mouth and throat cancers. The rise in HPV+ OPSCC. In this context, deintensification generally implies oropharyngeal squamous cell cancers owes its origin to the human a reduction in the intensity or duration of radiotherapy and/or papilloma virus (HPV), an etiologic agent previously recognized in chemotherapy. Transoral robotic surgery (TORS), which was cervical cancer. invented at Penn Medicine in 2004, became FDA cleared for benign and malignant T1 and T2 tumors in 2009. Research at Penn has HPV belongs to a family of non-enveloped DNA viruses with demonstrated that TORS is highly effective in the management of more than 100 genotypes. Of these, the variant HPV-16 is OPSCC independent of HPV status. Moreover, TORS has been strongly identified with both oropharyngeal squamous cell cancers used with great success as a primary therapy in OPSCC not followed (OPSCC) and overexpression of the P16 tumor suppression by adjuvant radiotherapy, and in the diagnosis and treatment of head protein. An expanding literature has defined the correlation between and neck cancers of unknown primary origin. p16-positivity and high-risk HPV, as well as the characteristics of the subpopulation of patients with oropharyngeal cancer for which The authors of the ongoing ECOG trial 3311 (Phase II Randomized p16+ HPV (HPV+ OPSCC) is the primary etiology. By contrast Trial of Transoral Surgical Resection Followed by Low-Dose or to the previously described traditional patient with OPSCC—a Standard-Dose IMRT in Resectable p16+ Locally Advanced middle-aged man with a history of alcohol and tobacco abuse— Oropharynx Cancer) have described the potential of TORS in HPV+ patients with HPV+ OPSCC are usually younger and much less oropharyngeal cancer succinctly: TORS allows more appropriate use of likely to smoke and drink. In clinical trials, these patients have postoperative adjuvant therapy based on pathologic staging. This valuable demonstrated better tumor control than their HPV-negative information has the potential to spare or diminish substantially the need counterparts, with significantly improved overall survival at five for high-dose radiation or concurrent chemoradiation in patients who are years with standard therapy dispite the tendency to be diagnosed expected to do well. Moreover such benefits are increased if the resection can with a relatively small primary but prominent neck nodes and hence be accomplished with low morbidity, which is the case with TORS. they almost uniformly present as advanced stage disease. TORS continues to be the impetus for new directions in research at Penn Medicine for HPV+ patients, as well as in other areas of treatment.

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MORE ON HUMAN PAPILLOMA VIRUS (HPV)

A Rapid Rise in HPV Related ffHuman papilloma virus (HPV)-related squamous Oropharyngeal Carcinoma 1988-2004 cell cancer of the oropharynx (OPSCC) accounts for ~25% of all squamous cell cancers of the head 10 and neck.

ffIn the developed world, greater than 50% of newly diagnosed OPSCC will test positive for HPV.

ffIncidence increasing 5% per year.

ffIn the US more than 11,000 HPV-related OPSCC are now diagnosed annually.

1 ffOf the 100 HPV types, about 40 types are sexually RATES PER 100,000 RATES transmitted and are drawn to the body’s mucous Oropharnyx (overall) membranes. The other ~60 types of HPV cause HPV-positive oropharnyx warts on areas such as the hands or feet. HPV-negative oropharnyx

0 1988 - 1990 1991 - 1992 1995 - 1996 1999 - 2000 2003 - 2004 CALENDAR YEARS Reference: National Cancer Database (1988-2004) - Analysis courtesy of Amy Y. Chen, MD, MPH, FACS

Trends in Treatment for Late Stage Oropharyngeal Cancers 1985-2007

100

70

60

X X 50 X X 40 X X X Surgery X RT 30 Chemo X ChemoRT 20 X PERCENTAGE OF PATIENTS PERCENTAGE X —— Linear (RT) X X X X X X —— Linear (Surgery) 10 X X X X X X —— Linear (Chemo) X —— Linear (ChemoRT) 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

DIAGNOSIS YEAR Reference: National Cancer Database (1985-2007) - Analysis courtesy of Amy Y. Chen, MD, MPH, FACS 9 NEW FACULTY

ffSteven B. Cannady, MD ffJonathan M. Lee, MD Assistant Professor of Otorhinolaryngology Assistant Professor of Otorhinolaryngology — Head and Neck Surgery — Head and Neck Surgery

Steven B. Cannady, MD joined Penn Otorhinolaryngology – Head Jonathan M. Lee, MD joined Penn Otorhinolaryngology – Head and and Neck Surgery and is practicing at Pennsylvania Hospital and Neck Surgery and is practicing at Penn Presbyterian Medical Center the Hospital of the University of Pennsylvania. and Penn Medicine Radnor.

Dr. Cannady received his medical degree from the Ohio State Dr. Lee received his medical degree from the Perelman School of University College of Medicine and Public Health. He completed Medicine at the University of Pennsylvania. He completed both his his otolaryngology residency program at the Head & Neck Institute internship in general surgery and his residency in Otorhinolaryngology — Cleveland Clinic and subsequently completed a microvascular – Head and Neck Surgery at the Hospital of the University of and head & neck surgery fellowship at Oregon Health Sciences Pennsylvania. University. He is board certified in otolaryngology. His clinical interests include: endoscopic sinus surgery, nasal airway He is the author/coauthor of numerous scientific publications and obstruction, thyroid and parathyroid surgery, obstructive sleep apnea, textbook chapters on head and neck cancer and reconstructive and salivary gland disorders. Dr. Lee focuses on a number of clinical surgery. His advanced training and passion for improving patient research projects. He is currently investigating the use of TransOral outcomes through reconstruction allow him to offer the most up- Robotic Surgery (TORS) as a novel technique for the surgical to-date rehabilitative options after cancer surgery. These techniques management of obstructive sleep apnea. and advances have improved speech, swallowing and appearance for patients undergoing cancer surgery.

Dr. Cannady’s ongoing patient-centered outcome studies and ff Steven J. Eliades, MD, PhD innovative new surgical techniques are research focuses that lead to Assistant Professor of Otorhinolaryngology — Head and Neck Surgery optimal patient satisfaction and quality of life after tumor surgery. High success rates with microvascular surgical procedures have Steven J. Eliades, MD, PhD joined Penn Otorhinolaryngology – allowed for expanded tumor removal and reconstruction options Head and Neck Surgery and is practicing at the Hospital of the for previously unresectable tumors. Conversely, new techniques in University of Pennsylvania. reconstruction after minimally invasive tumor surgery have lead to improved swallowing and speech after head and neck surgery. Dr. Eliades received his medical degree and completed his residency at In addition, Dr. Cannady performs nerve, muscle and bone The Johns Hopkins University. His clinical interests include hearing reconstructions in the head and neck for prior surgery or radiation loss and its treatment, cochlear implants, chronic ear disease, and resulting in numbness, scarring, pain, poor cosmetic outcomes, or disorders of balance including dizziness, vertigo, and Meniere’s disease. muscle weakness.

Dr. Eliades has a strong focus on both basic science and translational Dr. Cannady’s focus on patient functional outcomes helps research in hearing. His primary research interests are auditory-vocal individual patients achieve satisfaction and the best possible results integration, studying how the auditory system processes complex after cancer or other major head and neck surgery. sound inputs (e.g. speech or vocalization), and how the brain interprets the sound of our own voice and then uses this information to help control our speech. His research interests also include central auditory processing and cochlear implant-related auditory plasticity.

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Perelman Center for Advanced Medicine Penn Medicine University City Penn Medicine Washington Square South Pavilion Extension

NEW FACILITIES

ffPenn Medicine University City

Penn Medicine University City is an advanced treatment and Penn Otorhinolaryngology – Head and Neck Surgery moved outpatient facility that brings a multitude of specialties together, into Penn Medicine University City from its previous clinic space all under one roof. It strives to provide seamless, integrated care across the street at Penn Presbyterian Medical Center in August to patients. 2014. The new clinic space offers five exam rooms, one procedure room, and a wheel chair accessible audiology suite. Initially, this site Located at 3737 Market Street, Penn Medicine University City will offer general otorhinolaryngology services but has the space includes 200,000 square feet of exam rooms, outpatient operating necessary to expand into more subspecialized patient care. rooms for same-day surgeries, as well as an outpatient radiology center. ffPenn Medicine Washington Square

Serving as the main outpatient center for Pennsylvania Hospital, Penn Otorhinolaryngology – Head and Neck Surgery moved to Penn Medicine Washington Square is home to more than 100 health Penn Medicine Washington Square, located at 800 Walnut Street, care providers for a wide range of services, including cardiology, in October 2013. This site offers 12 exam rooms, two audiology otorhinolaryngology (ear, nose and throat), endocrinology, primary booths, and one Aesthetician treatment room, and provides General care, surgery, urology and women’s health. Together, in one Otolaryngology services with subspecialty care in Head and Neck convenient location, these practices enhance our ability to provide Cancer, Voice and Swallowing Disorders, Sleep Surgery, Facial Plastic comprehensive, patient-centered care to optimize outcomes. and Reconstructive Surgery, Audiology and Aethetician skincare. ffPerelman Center for Advanced Medicine South Pavilion Extension

The New Perelman Center for Advanced Medicine South Pavilion Penn Otorhinolaryngology - Head & Neck Surgery will move Extension is the most recent expansion for this state-of-the-art, to this new center in March, 2015. The new space has 31 exam outpatient facility adjacent to the Hospital of the University of rooms, one procedure room, a dedicated allergy treatment room, an

Pennsylvania. This expansion will allow for a comfortable and onsite CT machine, and a separate Audiology suite that includes easy-to-navigate environment for patients and provides the most five audiology booths. This new location will treat Head and Neck comprehensive, patient-centered care available in the region. Cancer, Sinus, Ear, Throat and Vestibular disorders, Allergies, Hearing Loss, Cochlear Implantation, Benign Tumors of Head and Neck, Thyroid and Skull Base and offer Facial Plastic and Reconstructive Surgery services.

11 Non-Profit Org. U.S. Postage 3600 Market Street | Suite 210 PAID Philadelphia, PA 19104 Permit No. 2563 Phila., PA 19104

PENN OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY

Founded in 1870, Penn Otorhinolaryngology is one of the oldest departments and residency programs in the country. The legacy and tradition of excellence in patient care, education, and research continues to grow and flourish today.

Penn’s multidisciplinary team of board-certified otorhinolaryngologists Penn PhysicianLink provides facilitated access to, and simplifies specializes in the evaluation, diagnosis and treatment of a spectrum the lines of communication between referring physicians and of ear, nose and throat disorders, as well as areas within the head Penn Medicine. This comprehensive, coordinated collection of and neck. support services expedites and facilitates both direct physician communication as well as patient transfers. SERVICES INCLUDE: Exclusive, Physician-Only Telephone Line: ffAudiology ffOtology/Neurotology 877.937.PENN (7366) ffBalance Center ffRhinology This dedicated, physician-only telephone line offers direct access ffCenter for Head and Neck ffSmell and Taste Center to facilitate: Cancer ffSpeech-Language • Emergent and non-urgent transfers to Penn Medicine ffCenter for Implantable Pathology and • Physician consults and referrals Hearing Devices Rehabilitation • Information about medical education and clinical programs ffCranial Base Surgery/ ffThyroid Program Skull Base Surgery ffTinnitus Physician Liaison Services: ffFacial Plastic and ffTransOral Robotic Reconstructive Surgery Penn Medicine physician liaisons will facilitate meetings between Surgery (TORS) and among referring physicians and Penn providers for Grand Rounds, ffGeneral Otolaryngology ffVoice, Speech and CME and education programs and other professional meetings. ffHead and Neck Surgery Swallowing Disorders ffHearing Aid Dispensing 877.937.PENN (7366) • PennMedicine.org/PhysicianLink

EXCELLENCE IN PATIENT CARE, EDUCATION AND RESEARCH SINCE 1870

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